No abstract available.
Colorectal Neoplasms*

BACKGROUND: The induced hypotensive anesthesia may produce serious complications related to central nervous system, heart, liver, kidney and eyes. In this study, the blood loss during and after operation were compared to evaluate the delayed effect of hypotension on postoperative bleeding and also, the urine output was measured in control group and furosemide treated group, to investigate the effect of furosemide on the protection of kidney function. METHODS: Forty patients undergoing spinal surgery were evaluated and the hypotension was induced by the combination of hydralazine, esmolol and propranolol under enflurane anesthesia. During hypotensive anesthesia, the systolic arterial blood pressure was maintained between 65 to 75 mmHg. I compared the arterial blood gas analysis, plasma protein, albumin and calcium level, blood urea nitrogen (BUN), creatinine and complete blood count (CBC) before, durng and after hypotensive anesthesia. And also, the volume of blood loss and the units of transfused blood were measured intraoperatively and postoperatively. To investigate the effect of furosemide on the protection of kidney function, patients were randomly divided to contol group (n=20) and furosemide group (n=20). In furosemide goup, 0.1 mg/kg was administered intravenously and the urine output was measured during and after hypotensive anesthesia in both groups. RESULTS: The systolic arterial blood pressure during hypotensive anesthesia was maintained between 65 to 75 mmHg as planned in all forty patients. The average blood loss during and after operation were 769+/-541 and 786+/-397 ml, respectively and the average total blood loss was 1555+/-784 ml. The average units of transfused packed red cell during and after operation were 2.6+/-0.8 and 1.9+/-0.4 units, respectively, and the average total transfused units were 2.3+/-0.8 units. In both control and furosemide treated groups, all forty patients showed oliguria during first two hours after starting hypotensive anesthesia but urine outputs were recovered after the end of hypotensive anesthesia in both groups. During and after hypotensive anesthesia, pH was slightly but significantly decreased. Plasma protein, albumin, calcium and BUN were decreased during and after hypotensive anesthesia compared with before hypotensive anesthesia values. During and after hypotensive anesthesia, platelet count was decreased significantly but white cell count was increased. Severe oliguria was noted during hypotensive anesthesia in both groups and no serious complication related to hypotensive anesthesia was found. CONCLUSIONS: In this study, the volume of blood loss after anesthesia was almost same as that during anesthesia. And the administration of furosemide 0.1 mg/kg did not prevent oliguria during hypotensive anesthesia.
Anesthesia* ; Arterial Pressure ; Blood Cell Count ; Blood Gas Analysis ; Blood Urea Nitrogen ; Calcium ; Cell Count ; Central Nervous System ; Creatinine ; Enflurane ; Furosemide* ; Heart ; Hemorrhage ; Humans ; Hydralazine ; Hydrogen-Ion Concentration ; Hypotension ; Kidney ; Liver ; Oliguria ; Plasma ; Platelet Count ; Propranolol

No abstract available.
Rectal Prolapse*

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce an ischemic damage on liver. The purpose of this study is to evaluate postoperative liver function according to the degree of induced hypotension in spine surgery. METHODS: Sixty patients were classified into three groups. In group 1 (n=20) undergoing simple laminectomy, the systolic blood pressure (SBP) was maintained at 120 to 100 mmHg with controlling the concentration of enflurane. Hydralazine and/or esmolol were given to maintain the SBP at 100 to 80 mmHg in group 2 (n=20) and 80 to 60 mmHg in group 3 (n=20) as needed. Preoperative and postoperative 1, 3, 5, 7 day's serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and postoperative SGPT levels were increased significantly on postoperative 7 day only. In group 2, postoperative SGOT levels were increased significantly on postoperative 1, 3, 5, 7 day and there was no significant difference between preoperative and postoperative SGPT levels. In group 3, postoperative SGOT levels were increased significantly on postoperative 1, 3 day and postoperative SGPT levels were increased significantly on postoperative 3, 5, 7 day. There was no significant difference among three groups in SGOT and SGPT levels. Postoperative ALP levels were decreased on postoperative 1, 3, 5, 7 day in all groups and there was no significant difference among three groups except a significant difference between group 1 and 3 on postoperative 1, 3 day in ALP levels. CONCLUSIONS: These results suggest that severe reduction in SBP at 80 to 60 mmHg by hydralazine and/or esmolol under general anestheia with enflurane can not exclude the possibility of liver damage.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Aspartate Aminotransferases ; Blood Pressure ; Enflurane ; Humans ; Hydralazine ; Hypotension ; Laminectomy ; Liver* ; Pyruvic Acid ; Spine*

BACKGREOUND: Several formulas for estimating allowable pre-transfusion blood loss were used to reduce unnecessary intraoperative blood replacement. The postoperative predicted hematocrit computed by formula was compared with the actual hematocrit and was tested which formula was more accurate in spine surgery. METHOD: Total blood volume was estimated in spine surgery of 34 patients. The target hematocrit (Hct) was suggested on 30% and the allowable blood loss was computed using the formula 1 and 2. For each patients, simultaneous measurement of blood loss and Hct was obtained at the end of operation. The postoperative predicted Hct by the formula 1 and 2 was calculated and compared with the actual Hct, and the difference between the formula 1 and 2 was evaluated. Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Initial Hct ... Formula (1) Allowable blood loss=Estimated blood volume (Initial Hct Target Hct)/Average Hct ... Formula (2) RESULTS: 1) The preoperative Hct was 40.7 3.9%. The postoperative predicted Hct by the formula 1 and 2 were 34.3 4.6 and 34.9 4.3% respectively. The postoperative actual Hct was 30.1 4.6%.2) The difference between the predicted Hct by the formula 1 and the actual Hct was 4.2% (P<0.05). The difference between the predicted Hct by the formula 2 and the actual Hct was 4.8% (P<0.05). The difference between the predicted Hct by the formula 1 and 2 was 0.6% (P<0.05). It was thought that the predicted Hct by the formula 1 was more closer to the actual Hct. CONCLUSIONS: The predicted Hct by both formulas is underestimated when the results compare with the actual Hct. But the predicted Hct by the formula 1 provides a closer results to the actual Hct than the predicted Hct by the formula 2.
Blood Volume ; Hematocrit* ; Humans ; Spine

BACKGROUND: Induced hypotension reduces blood loss in the surgical field and provides better visibility, but may produce ischemic damage to the liver. The purpose of this study is to compare liver function after induced hypotension between general anesthesia with enflurane and isoflurane in spinal surgery. METHODS: Forty patients were randomly allocated to enflurane (group 1, n = 20) and isoflurane (group 2, n = 20) group. During operation, hypotension was induced with hydralazine to maintain systolic blood pressure between 60 to 80 mmHg in both groups. Preoperative and postoperative 1, 3, 5 and 7 days' serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvate transaminase (SGPT) and alkaline phosphatase (ALP) were evaluated. RESULTS: In group 1, SGOT levels increased significantly at postoperative 1, 3 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days. In group 2, SGOT levels increased significantly at postoperative 1, 3, 5, 7 days, and SGPT levels increased significantly at postoperative 3, 5, 7 days, but there was no significant difference between the groups in SGOT and SGPT levels. ALP levels decreased at postoperative 1, 3, 5 days in group 1, and at postoperative 1, 3 days in group 2; however, there was no significant difference between the groups in ALP levels except in preoperative values. CONCLUSIONS: These results suggest that there is no difference in postoperative liver function between general anesthesia with enflurane and isoflurane in spinal surgery after induced hypotension.
Alanine Transaminase ; Alkaline Phosphatase ; Anesthesia* ; Anesthesia, General ; Aspartate Aminotransferases ; Blood Pressure ; Enflurane* ; Humans ; Hydralazine ; Hypotension* ; Isoflurane* ; Liver* ; Pyruvic Acid

The transarterial embolization has been widely used to control bleeding. It has a variety of clinical utility; to reduce bleeding on the surgical field, to reduce the size of malignant tumor as a preopearative treatment, to treat arteriovenous malformation or arterial aneurysm as a curative method and to promote life qua' ity of patient with diffuse or multiple hepatocellular carcinoma as a palliative treatment, etc. With the advance of modem technology, various embolic materials have been also developed. IIowever, it has not- been -fully investigated of histopathologic changes of the embolized organs according to the embolic materials used. This study was undertaken to investigate the histopathologic changes of embolized renal artery in rabbit by various embolic materials, according to each embolic material and to time passed by after embolization. Of the 5 arteries embolized by ethylene vinyl alcohol copolymer(EVAL), one showed abscess formation in embolized kidney. The other 4 allowed to perform further pathologic study: within a week after embolization there was no any specific change in vessels, however, r,unimal endothelial hypertrophy was observed following 2 weeks of embolization. Of the 8 renal arteries embolized by N-buthyl-2-cyanoacrylate(Histoacryl), 4 showed total occlusion of the main renal arteries as well as renal infarction, which reflects the strong adhesiveness of Histoacryl to vascular wall. The other 4 showed fibrinoid degeneration in vascular wall within a week. However, further change was not observed thereafter. In all the 5 renal arteries embolized by polyvinyl
Abscess ; Adhesiveness ; Aneurysm ; Arteries ; Arteriovenous Malformations ; Carcinoma, Hepatocellular ; Enbucrilate ; Hemorrhage ; Humans ; Hypertrophy ; Infarction ; Kidney ; Modems ; Palliative Care ; Polyvinyls ; Renal Artery*

Epidural injection of morphine is widely used for relief of postoperative pain. However urinary retention, the side effect, following epidural morphine is troublesome for patient. A 45 year old male patient was admitted due to avascular necrosis of right hip joint and received bipolar endoprosthesis under continuous epidural anesthesia with 2% lidocaine 15 ml. In recovery room after operation, we applied 2 day,s continuous drug infusor (Baxter Infusor(R), Baxter Healthcare Co., USA) with morphine 2 mg and fentanyl 300 g in saline through epidural catheter. At 2 hour after operation, morphine 2 mg was added to the continuous drug infusor due to severe surgical pain. In ward, at 5 hour, he complained of voiding difficulty and abdominal distension. At 6 hour, Nelaton catheter was inserted and 1000 ml of urine was voided. On the 1st postoperative day, the continuous drug infusor was removed and he received naloxone 0.1 mg, two times, intravenously. But voiding difficulty was persisted. Intermittent Nelaton catheter or indwelling Foley catheter was inserted alternatively. Bethanechol chloride (Besacholine(R)) 15~90 mg/day and prazosin hydrochloride (Minipress(R)) 2~3 mg/day were administered orally and hot bag was applied on lower abdomen. On the 25th postoperative day, he was ultimately released from voiding difficulty and discharged without any problems. We suggested that the causes of urinary retention were bladder atony by overdistention of the bladder and contraction of internal urethral sphincter following epidural anesthesia, surgical pain and immobilization.
Abdomen ; Anesthesia, Epidural ; Bethanechol ; Catheters ; Delivery of Health Care ; Fentanyl* ; Hip Joint ; Humans ; Immobilization ; Infusion Pumps* ; Injections, Epidural ; Lidocaine ; Male ; Middle Aged ; Morphine* ; Naloxone ; Necrosis ; Pain, Postoperative ; Prazosin ; Recovery Room ; Urethra ; Urinary Bladder ; Urinary Retention*

The effect of pancuronium on induced hypotension by histamine and d-tubocurarine was investigated in the rabbit. The results are summarized as follows; 1) Intravenous diphenhydramine(5ug) pretreatment attenuated the arterial hypotension induced by 3ug of histamine and 30ug of d-tubocurarine. 2) Pancuronium in doses of 1ug, 3ug, 10ug and 30ug produced an attenuation of the vaso depressor action of histamine 3pg but was not does dependent and the depression rate was 20%, 25%, 24% and 49% respectively. 3) Pancuronium in dose of 0.3ug, lug, 3ug and 10ug produced to attenuate the vasode-pressor action of d-tubocurarine 30ug, which it was dose dependent attenuation of vasode-pressor action at dose from 0.3ug to 3ug and depression rate was 19%, 26%, 52% and 20% respectively.
Depression ; Histamine ; Hypotension* ; Pancuronium* ; Tubocurarine*

Bond strength of luting cements to dentin is a critical consideration for success of complete cast crowns. This study was performed to evaluate the relationship between surface characteristics of teeth prepared for complete cast crowns and retention of cemented restorations. Eighty artificial crowns were cast for standardized complete crown tooth preparations accomplished with the use of a special device on recently extracted human teeth. Coarse diamond(#102R, Shofu) and superfine finishing diamond(#SF102R, Shofu) burs of similar shape were used. Crowns in each group were randomly subdivided into four subgroups of 10 for luting cements selected for this study: zinc phosphate cement (FLECK'S), polycarboxylate cement (Poly-F), reinforced glass ionomer cement (Fuji PLUS), and adhesive resin cement (Panavia 21). Retention was evaluated by measuring the tensile load required to dislodge the artificial crown from tooth preparations with an Instron testing machine, and analysed by one-way ANOVA and Student's t-test. The obtained results were as follows ; 1. When tooth preparation was done with coarse diamond bur, retentive force was diminished in order of Panavia 21, Fuji PLUS, FLECK'S, and Poly-F. Retentive forces showed the significant difference between Fuji PLUS group and FLECK'S group(p<0.001). 2. When tooth preparation was done with superfine diamond bur, retentive force was diminished in order of Fuji PLUS, Panavia 21, FLECK'S and Poly-F. Retentive forces showed the significant difference between Panavia 21 group and FLECK'S group(p<0.001). 3. Retentive force in coarse tooth surfaces was significantly higher than that in superfine tooth surface with all luting cements(p<0.001), and cement residues were almost retained with in the cast crown in all groups.
Adhesives ; Crowns* ; Dental Instruments ; Dentin ; Glass Ionomer Cements ; Humans ; Polycarboxylate Cement ; Resin Cements ; Tooth Preparation ; Tooth* ; Zinc Phosphate Cement